The Anatomy of the Male Inferior Hypogastric Plexus: What Should We Know for Nerve Sparing Surgery.

Röthlisberger, Raphael; Aurore, Valerie; Boemke, Susanne; Bangerter, Hannes Christoph; Bergmann, Mathias; Thalmann, George; Djonov, Valentin Georgiev (2018). The Anatomy of the Male Inferior Hypogastric Plexus: What Should We Know for Nerve Sparing Surgery. Clinical anatomy, 31(6), pp. 788-796. Wiley-Blackwell 10.1002/ca.23079

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INTRODUCTION The aim of this study was to investigate the nerve supply to the structures in the male lesser pelvis and review its clinical relevance, especially during nerve sparing surgery. MATERIAL AND METHODS Three formalin-embalmed and 16 Thiel-embalmed male hemipelves were used. They were microdissected after repeated treatments with nitric acid diluted 1:10 with milliQ-water. RESULTS The inferior hypogastric plexus is a fan-ike structure lateral from the rectum on the fascia of the levator ani. Nerves emerging from the proximal, solid part of the plexus follow the internal iliacal vessels and reach the prostate from dorsolateral. The innervation of the urethra and the corpora cavernosa derives from two origins: one follows the ejaculatory duct and the seminal vesicle, reaching the proximal urethra and the prostate from dorsal; the other follows the inferior vesical artery to reach the prostate from lateral, and then forms the neurovascular bundle on both sides of the prostatic fascia, spreading to the pelvic floor muscles and the corpora cavernosa along with the distal urethra. A connection between the two parts was demonstrated in approximately one third of the samples investigated. CONCLUSION The nerve supply to the urinary bladder, the urethra, and the corpora cavernosa emerges mainly from the inferior hypogastric plexus. The innervation of the proximal urethra and its autonomic muscular structures has a dorsal (ejaculatory duct) and lateral (inferior vesical artery) origin. To maintain good erectile and continence function it is important to save both the dorsal and lateral neurovascular roots. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Anatomy
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Röthlisberger, Raphael; Boemke, Susanne; Bangerter, Hannes Christoph; Bergmann, Mathias; Thalmann, George and Djonov, Valentin Georgiev

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0897-3806

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Laetitia Hayoz

Date Deposited:

03 Jul 2018 11:38

Last Modified:

26 Mar 2019 02:30

Publisher DOI:

10.1002/ca.23079

PubMed ID:

29577446

Uncontrolled Keywords:

hypogastric plexus lesser pelvis male urethra microdissection nerve sparing pelvic floor prostate seminal vesicles urinary bladder

BORIS DOI:

10.7892/boris.118230

URI:

https://boris.unibe.ch/id/eprint/118230

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